US6939364B1 - Composite tissue adhesive - Google Patents
Composite tissue adhesive Download PDFInfo
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- US6939364B1 US6939364B1 US09/973,335 US97333501A US6939364B1 US 6939364 B1 US6939364 B1 US 6939364B1 US 97333501 A US97333501 A US 97333501A US 6939364 B1 US6939364 B1 US 6939364B1
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- collagen
- tissue
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- adhesive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00057—Light
- A61B2017/00066—Light intensity
- A61B2017/0007—Pyrometers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00084—Temperature
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
- A61B2017/005—Surgical glue applicators hardenable using external energy source, e.g. laser, ultrasound
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
- A61B2017/00504—Tissue welding
- A61B2017/00508—Tissue welding using laser
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
- A61B2017/00513—Tissue soldering
- A61B2017/00517—Tissue soldering using laser
Definitions
- Tissue joining and sealing utilizing sutures and staples is the keystone in modem surgical procedures.
- An alternative approach utilizes a laser to expose a glue or solder to thereby join adjacent tissues.
- laser assisted tissue soldering is superior to conventional suture or staple-based methods.
- the advantages are speed, reduced infection, acceleration in healing, better cosmetic appearance and ease of use particularly in laparoscopic surgery where water tightness and limited access or small size of the repair are important.
- Laser assisted tissue welding often requires glues or solders for promoting strong bonds, forming a bridge between two apposed tissue sections.
- the ideal solder is chemically and mechanically matched to the tissue. As a result the solder is strong but stretches and grows with the tissue because of good modulus match. Chromophores mixed with the solder can assist in confining the deposited energy and reduce the impact of tissue imperfections. These additives, however, may be toxic and cause pernicious effects.
- a suitable solder and associated laser welding system are provided which avoid the shortcomings of conventional systems described above.
- the biological solders and sealants consistent with the present invention are biodegradable and do not require chormophores or dyes to promote adhesion.
- the laser system provides accurate temperature control to eliminate peripheral tissue damage, damage to stay sutures (if required), and large area exposure to reduce treatment time. Further, the use of a feedback controller reduces required surgeon skill.
- the laser system can be comprised of inexpensive off-the-shelf components and has been designed to be compact, nonintrusive in a surgical setting, inexpensive to manufacture and user friendly.
- the laser energy disrupts the three-dimensional structure of collagen fibers found in tissues, promoting tissue crosslinking and improving cohesive strength.
- the films or gels are easy to apply and fix to the tissue surface.
- compositions for use with the laser system.
- the compositions are comprised of chemically derivatized soluble collagen, which is formulated to concentrations ranging from 300 mg/ml (30%) to 800 mg/ml (80%) collagen protein.
- Type I collagen for example, is first prepared by extraction from animal hide, skin or connective tissue and purified. The collagen preparations are then chemically derivatized with sulfhydryl reagents to improve cohesive strength and with secondary derivatizing agents, such as carboxyl groups, to improve the adhesive strength of the solder to the tissue.
- compositions are then formed into liquid, gels or solid films which when exposed to energy generated from an infrared laser, for example, undergo thermally induced phase transitions.
- Solid or semi-solid protein compositions become less viscous enabling the high concentration protein to penetrate the interstices of treated biological tissue or to fill voids in tissue.
- the protein compositions again become solid or semi-solid, adhering to the treated tissue or tissue space.
- minute quantities of any derivative of commercially available, medical grade cyanoacrylate can be applied to fix and appose tissue edges.
- a layer of the high concentration collagen can be applied adjacent to and on the surface of the tissue to be bonded.
- This top layer is typically exposed to an infrared laser to melt, denature, and mix the two components to promote both chemical and mechanical bonds to the tissue as well as enhancing intrinsic strength of the composite solder.
- Infrared laser exposure increases temperature at the bonding site.
- Feedback control of the laser can be used to adjust solder temperature for optimizing the bonding mechanism to the tissue while preventing thermal damage to adjacent healthy tissue.
- high concentration collagen compositions described in this invention have an increased volume of linkages to improve the strength performance of the solder while modulating the thermal melt temperatures and solder viscosities.
- Laser exposure parameters were chosen to rapidly flow the solder and promote physical contact of the solder with the tissue. These parameters include choice of an operating wavelength in the infrared range, power density, pulsed or cw mode, exposure times and tissue temperature. The following examples are illustrative of the invention but are not intended to limit the scope thereof.
- FIG. 1 illustrates an application of a tissue solder, which can be in liquid, gel or solid form, consistent with the present invention to bond two adjacent tissues;
- FIG. 2 illustrates an additional application of a tissue solder, which can be in liquid, gel or solid form consistent with the present invention to bond two adjacent tissues;
- FIG. 3 illustrates an application of a tissue solder, which can be in liquid, gel or solid form consistent with the present invention to bond inner surfaces two adjacent tissues;
- FIG. 4 illustrates an additional application of a tissue solder, which can be in liquid, gel or solid form consistent with the present invention to bond inner surfaces of two adjacent tissues;
- FIG. 5 illustrates a temperature monitoring and laser control system in accordance with a further feature of the present invention
- FIG. 6 illustrates an adhesive patch consistent with a further aspect of the present invention
- FIG. 7 illustrates a mold used to make the patches shown in FIGS. 6 , 8 and 9 ;
- FIGS. 8 and 9 illustrates additional exemplary adhesive patches consistent with the present invention.
- FIG. 10 illustrates a graph of minimum strengths of welded tissues.
- Type I collagen is the most abundant of the twenty characterized collagens and is commonly used as a biomaterial for medical devices.
- Collagen-based devices include hemostats, bulking agents, eye shields, punctal plugs, adhesives, drug delivery systems, and others.
- Collagen is well known to be a biocompatible and safe biomaterial.
- collagen is isolated and purified from various tissue sources including dermis, tendon and ligaments. While collagen is currently prepared from human dermis, most commercial products are prepared using collagen from animal sources. Once a pure form of collagen is prepared, it can be treated in several ways to provide a suitable base protein for use as an adhesive or sealant. These treatments include chemical derivitazation to add functional or reactive groups as well as reduce the pKa of the solder to a more acidic value, and gelatinizing the collagen to create a viscous liquid, gel or solid film having a relatively high protein concentration.
- the exemplary solder formulations described herein are suitable for infrared laser activation and include chemically derivatized bovine Type I collagen formed into a liquid, gel or solid film.
- Collagen was chosen due to its long history as a safe, biocompatible biomaterial and due to its ability to be chemically functionalized into a base formulation with unique cohesive and adhesive characteristics.
- Type I collagen was prepared from calf corium. Corium was cut into small pieces approximately 1 cm 2 , soaked in reagent alcohol and extensively washed with sterile, deionized water. The washed pieces were then swollen in acetic acid and digested using porcine mucosal pepsin (Sigma Chemical Company, 1:60,000 crystallized and lyophilized). Following 1 or more pepsin treatments, residual pepsin was removed by dialysis and Type I collagen isolated by differential salt precipitation. Purified Type I collagen was dialyzed against acetic acid and filtered through 0.45 ⁇ and 0.22 ⁇ filters.
- Solder formulations prepared from calf collagen were not successful unless the solutions were extensively dialyzed to remove residual salt (NaCl) and filtered through a 0.22 ⁇ filter. It is believed that 0.22 ⁇ filtration is required to produce monomolecular collagen for subsequent chemical derivatization. Details of pure, soluble Type I bovine collagen are described in U.S. Pat. Nos. 4,713,446; 5,104,957; 5,219,895; 5,476,515; 5,631,243, each of which is incorporated by reference herein. An exemplary collagen purification process is provided below.
- Derivatization was intended to provide functional groups to enhance both cohesive and adhesive characteristics.
- thiol groups were attached by derivatization using 4-mercapto-1,8-naphthalic anhydride. Adjacent thiol groups react to form disulfide bonds between collagen molecules enhancing the cohesive properties of this solder.
- monomolecular collagen is derivatized with glutaric anhydride. This reaction substitutes a COO ⁇ for a NH 3 + making the composition anionic. It is believed that the net negative charge of the solder will ionically interact with positive charged proteins in tissues.
- the derivatization is conducted such that the resultant solder will exhibit a thermal transition at approximately 40–50° C. when exposed to IR laser energy.
- the solution was centrifuged at 3500 rpm for 10 minutes.
- the pH of the solution was adjusted to pH 6.8–7.8 as necessary. This solution was lyophilized or air-dried.
- Collagen was also prepared with glutaric anhydride alone or with no derivatization. In the latter case, acid soluble collagen was precipitated at neutral pH and lyophilized or air-dried.
- Solder formulations were prepared from chemically derivatized Type I collagen.
- Base compositions contained either COO ⁇ functional groups or both SH ⁇ (thiol) and COO ⁇ functional groups.
- the degree of derivatization with SH ⁇ functional groups was varied in attempts to modulate cohesive characteristics. Remaining free amine groups on the native collagen molecule were derivatized with COO ⁇ groups.
- compositions contained approximately the same total net derivatization with SH ⁇ and COO ⁇ groups.
- the ratio of SH ⁇ /COO ⁇ was intentionally varied.
- Base preparations contained only COO ⁇ groups. Derivatized collagen solutions were then lyophilized (or air dried and powdered).
- Lyophilized derivatized collagens were formulated into viscous compositions having from 30–80% collagen solids. Since collagen typically becomes saturated at less than 10% solids, novel techniques were developed to increase total collagen concentrations to 30–80%. This was accomplished by mixing lyophilized or powdered collagen preparations in 0.02M phosphate buffer at pH 6.8–7.8. Mixtures of approximately 50 mg/ml were initially prepared and exposed to thermal energy, in this case microwave energy (output power of 1100 watts, 100% power for 3–5 seconds). Microwave energy generates thermal energy causing the gelatinization of collagen. Other heating methods can be employed such as direct application of a heat source at 50 C, for example. Lyophilized or dried collagen was added to the gelatinized collagen solution and again exposed to microwave energy.
- the final viscous and adhesive formulation was centrifuged at 3500 rpm for 1 minute.
- the high concentration preparations were then cast into films by pouring hot, centrifuged gelatinized collagen in molds approximately 1 mm thick, and 4 cm square in size. Solidified gelatinized collagen films were sectioned into strips for use with the infrared laser system.
- An alternate method of preparing films was to gently roll the centrifuge tubes used to deaerate the thick gelatinized collagen formulations.
- the hot, thick formulation coated the inner surface of the centrifuge tubes in a uniform thickness. Films were removed form the tubes and sectioned into strips for use with the infrared laser system.
- FIG. 1 illustrates an exemplary application of the solder or gel and associated laser system consistent with the present invention.
- First and second tissues 110 and 120 to be joined together are brought within close proximity with one another.
- a layer of gelatinized solder 130 to be used as an adhesive is then provided overlying the location where the tissues are to be joined.
- the solder is then exposed to electromagnetic radiation 140 , which in this example, includes infrared light generated by a laser.
- electromagnetic radiation 140 includes infrared light generated by a laser.
- the solder becomes less viscous and therefore flows, for example, into region 150 at the junction of the two tissues 110 and 120 .
- the solder penetrates the interstices of tissues 110 and 120 and fills voids located in region 150 .
- the derivatized collagen within the solder crosslinks as well as crosslinking to the underlying tissues. Withdrawing the laser causes the solder to harden and become solid or semi-solid and adhering to the treated areas.
- Direct bonding of many tissues can be achieved using the inventive derivatized collagen adhesive alone. Additional adhesive strength, however, can be obtained for bonding some vascular and peritoneal tissues by providing a layer of cyanoacrylate containing material to the tissues prior to application of the derivatized collagen adhesive.
- a layer of cyanoacrylate 210 (n-butyl or n-octyl cyanoacrylates, for example) can be initially applied to tissues 110 and 120 .
- the cyanoacrylate layer is believed to interact with NH 2 groups in protein molecules in tissues 110 and 120 to initiate nucleophiles, kicking-off monomer polymerization and bonding to protein surfaces.
- derivitized collagen formulations as discussed above, were combined with n-butyl or n-octyl cyanoacrylates, as shown in FIG. 2 .
- the collagen-based solder, and the tissue surface contain NH 2 moieties to initiate polymerization leading to primary chemical bonding with the polymerized cyanoacrylate. This event results in bonding of the solder to the tissue surface.
- exposure of the collagen solder to the laser 140 produces enough heat to induce a phase transition of the collagen-based solder from solid or gel to liquid to thereby permit more efficient mixing of the solder with the cyanoacrylate monomer and facilitate penetration of the collagen-based solder into the tissue surface.
- the former encourages monomer reaction with both the solder and the tissue, and the latter results in some degree of mechanical bonding of the solder with the interacting treated tissue.
- FIGS. 3 and 4 Alternative applications are next shown in FIGS. 3 and 4 .
- derivatized solder layers 310 and 320 are applied to the inner surfaces of tissues 120 and 110 , respectively, and exposed to laser light 140 at the interface between tissues 110 and 120 to complete the welding process.
- cyanoacrylate layers 410 and 420 are applied to inner surfaces of tissues 120 and 110 , respectively.
- derivatized collagen solder layers 430 and 440 are applied to layers 410 and 420 , respectively, and exposed to laser light in a manner similar to that described above to thereby facilitate bonding of the two tissue layers.
- FIG. 5 illustrates a laser control and monitoring apparatus 500 in accordance with a further feature of the present invention.
- an energy source 510 such as a semiconductor laser emitting light having a wavelength in the infrared range, supplies electromagnetic radiation to a delivery fiber 520 .
- the wavelength output from energy source 510 is selected to correspond to an absorption peak of water to thereby effectuate a more efficient coupling of energy from source 510 to target 530 (including the above described solder disposed on a tissue to be joined or bonded together).
- a second fiber 540 having an end in proximity to the target 530 directs electromagnetic radiation emitted by the target to a temperature sensor circuit 550 .
- the sensed radiation is detected by circuit 550 which generates a sense signal in response to a temperature of the target.
- Control circuit 560 receives the sense signals and outputs a control signal 510 to thereby adjust an intensity of laser light output from source 510 .
- the output intensity of source 510 is controlled in accordance with the temperature of target 530 .
- Descending aorta sections were collected from juvenile pigs and stored frozen. Prior to use the tissue, contained in a sealed bag, was thawed 15–20 min in a water bath at room temperature (23° C.). The thawed aorta were cut with a standard single-edged razor blade into 1 cm ⁇ 1 cm coupons. Excess fascia and loose tissue were removed. The coupons were transferred to a PBS 1X solution that was placed in an ice bath until use.
- the coupons were cut into two 0.5 cm ⁇ 1 cm pieces and assembled in a butt joint configuration.
- the incision was first warmed with the laser operating in the 1.4–1.5 micron wavelength range.
- Laser power density was approximately 10 W/cm2.
- a minute quantity of medical grade cyanoacrylate is applied sparingly to the apposed tissue edges and thick collagen gels or films were then applied directly to the cut surfaces intended for the joint and subsequently exposed to the laser at a controlled temperature of 55° C.
- the laser beam was scanned over the entire gel or film for a period of 2–3 min.
- the gels or films underwent thermal melting.
- the high concentration fluid covered the incision and penetrated the tissue interstices. Rapid cooling was observed once the laser beam was withdrawn.
- FIG. 10 summarizes the results. As shown on the first bar of the graph, the minimum strength of the welded tissue was calculated using Laplace's law. An aorta subjected to 180 mmHg blood pressure will achieve a wall stress of 1000 g/cm 2 . From the experiment, it was found that the combining of the cyanoacrylate and collagen solder had a strength 5 times the minimum required strength. However, the collagen alone or the cyanoacrylate alone achieved a lower maximum strength.
- a collagen-based composition comprised of Type II collagen may be preferred in the treatment of articular cartilage lesions.
- One method of preparing Type II collagen is described for example in U.S. Pat. No. 5,840,848 incorporated by reference herein.
- a tissue adhesive patch 600 can be used to bond tissues instead of layers 130 , for example, discussed above.
- a patch 600 consists of a mesh 610 formed of a polymer (e.g. nylon, polyester or polycarbonate), carbon or metal wire that is biologically compatible and non-irritating.
- the mesh is comprised of a cojoinal network which is encapsulated in a derivatized collagen liquid, gel or solid 620 , as discussed above.
- the mesh can be pre-treated with a combination of etchants, acids or cleaning solutions to enhance the adhesiveness to the base derivatized collagen 620 , as discussed above.
- Patch 600 has increased strength, flexibility or desired electrical characteristics due to the presence of mesh 610 .
- a plurality of fibers 810 (made of biologically compatible and non-irritating material such as a polymer (e.g. nylon, polyester, polycarbonate), carbon or metal can be dispersed throughout layer 620 , which can either be oriented randomly ( FIG. 8 ) or coaligned ( FIG. 9 ) to give additional strength, flexibility, uniform heating or electrical properties to the patch 600 .
- a polymer e.g. nylon, polyester, polycarbonate
- carbon or metal can be dispersed throughout layer 620 , which can either be oriented randomly ( FIG. 8 ) or coaligned ( FIG. 9 ) to give additional strength, flexibility, uniform heating or electrical properties to the patch 600 .
- Patch 600 can be formulated by placing a structural element such as fibers 810 or mesh 610 in a recessed portion 710 of mold or template 700 , as shown in FIG. 7 . Heated derivatized and concentrated collagen, as discussed above, is poured or otherwise supplied to recess 710 and allowed to cool. Patch 600 is then removed from opening 710 and can be exposed to laser light or other electromagnetic radiation to bond or weld tissues in a manner similar to that discussed above. By precisely filling opening 710 , patch 600 can be formed with a uniform thickness thereby assuring adequate and uniform bonding of the underlying tissue upon exposure.
- collagen fibrils, fibers, or fiber bundles can be added to the base solder composition to encourage integration of cells and binding of cells from host tissue.
- Collagen fibrils may be prepared by reconstituting acid soluble or acid soluble-pepsin digested collagen from human or non-human animal sources.
- Collagen fibrils may be composed predominantly of Type I collagen, Type I collagen/Type III collagen mixtures, Type II collagen, or other collagen Type mixtures. Acid soluble and acid soluble-pepsin digested collagen undergo spontaneous reconstitution (fibrillogenesis) when brought to neutral pH conditions.
- Collagen fibrils, fibers, or fiber bundles are added to the base solder composition following centrifugation to remove incorporated air (deaeration).
- the dispersed fibrils, fibers, or fiber bundles are gently mixed with an appropriate mixing tool, i.e., spatula, mixing rod, etc., into the viscous composition avoiding production of air bubbles. If air bubbles are again incorporated, the mixture may be re-centrifuged at lower speed. Higher speeds will result in settling of the fibrils, fiber, or fiber bundles necessitating remixing to form a homogeneous composition.
- Fibril, fiber, or fiber bundle supplemented solder is then cast into films or membranes as described above.
- the composition may be placed in an appropriate delivery system, i.e., syringe or tubular device, such that the solder is able to be delivered by exerting pressure to forcing it through a delivery orifice (caulking gun approach) in a continuous stream.
- Collagen fibrils, fibers, or fiber bundles are added to the base solder composition at concentrations (wet weight/volume) ranging from 1%–30%, preferably 5%–20%, and more preferably, 7.5%–15%. Since the addition of intact collagen fibrils, fibers, or fiber bundles increases the total concentration of the solder, it may be necessary to reduce the concentration of the base solder.
- fibril, fiber, or fiber bundle solder compositions will encourage host cell integration, cell binding, and cell proliferation.
Abstract
Description
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- 1) Remove about 25 grams of bovine skin (split calf hide) and cut into small pieces using a scalpel and blade. Wash the skin with sterile, deionized water.
- 2) Cut the skin into small pieces using a scalpel blade. Weigh pieces and place in a 4 liter beaker containing 3 liters of 0.5M acetic acid. (This is 28.6 ml of concentrated acetic acid per liter or a total of about 86 ml. Add the 86 ml of acetic acid to 3 liters of water).
- 3) Attach stirrer and stir for 18 hours.
- 4) Add 2% pepsin to the container. First weigh out 0.5 grams of pepsin and dissolve in 50 ml of deionized water. Then add to the beaker.
- 5) Continue stirring for 12 hrs. If all of the skin pieces have not dispersed into the acetic acid, add another aliquot of 1% pepsin or 0.25 gram of pepsin powder. Stir for 12 hrs.
- 6) Filter the suspension through cheesecloth to remove pieces of skin that have not dispersed into the acetic acid. (remove a small sample for analysis-40 ml in a 50 ml centrifuge tube and place in refrigerator.
- 7) Add solid NaCl (salt) to 0.8 M. This is 140 grams. Add while stirring the collagen solution. Stir for at least two hours to precipitate collagen. Allow the precipitate to settle for 12 hrs.
- 8) Siphon-off the clear liquid leaving the collagen precipitate. Then centrifuge the precipitate in centrifuge bottles and collect all the precipitate. Weigh and redissolve in 3 liters of 0.5M acetic acid. (see above for details in preparing the acetic acid solution). Stir for 12 hrs.
- 9) Take sample of solution, 40 ml in a 50 ml centrifuge tube and cool to 5 C.
- 10) Again add solid NaCl to 0.8M. Same as above. Stir for at least 2 hrs or until the precipitate is dissolved. Allow precipitate to settle for 12 hrs and centrifuge to collect the pellet. Weigh and redissolve in 0.1 M acetic acid (add 12 ml of acetic acid to 2 liters of deionized water).
- 11) Stir for 12 hrs to redissolve the collagen. Then dialyze the collagen solution using Spectrapore dialysis tubing, >30,000 molecular weight cut-off. This step will remove dissolved pepsin. Then dialyze against 0.1M acetic acid.
- 12) Dialyzed volumes will then be filtered through 0.45μ and then 0.2μ filters and stored in 1 liter or 4 liter bottles in the refrigerator. This is the collagen stock solution for making collagen-based solder formulations.
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